Provider First Line Business Practice Location Address:
S 820 MCCLELLAN ST
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-8168
Provider Business Practice Location Address Fax Number:
509-838-8256
Provider Enumeration Date:
08/04/2006